What medications should I use against pain and fever?
The best-selling drugs in the world are antipyretic and analgesic. With the advent of winter and the rise in the incidence of influenza, their popularity is only growing. We will explain how drugs differ from each other and what of this variety should be chosen to reduce the temperature.
Drugs that knock down the temperature and simultaneously have an anesthetic and anti-inflammatory effect form a whole group of non-steroidal anti-inflammatory drugs (NSAIDs). The word “nonsteroidal” indicates that they are not hormonal, and therefore do not have those side effects that steroids give.
If you want to bring down the temperature and get rid of the pain, you should understand that these are only symptoms of a disease. Therefore, when choosing a medicine, you should evaluate the risk of side effects and the use of the drug. It is better to suffer temperature and pain than to lower the temperature and hurt yourself additionally.
What are antipyretic drugs
Only 25 years ago there were only 8 major groups of non-steroidal anti-inflammatory drugs, now their number has reached 15, but no one can say the exact number. Original medicines from this group all over the world are registered about 100-150 names, and generics – thousands. The nonsteroidal anti-inflammatory drugs that were developed immediately gained popularity and replaced opioid analgesics, because, unlike them, they did not depress breathing and they had less pronounced analgesic effect.
All NSAIDs are divided into two groups:
“Old” drugs (first generation): acetylsalicylic acid, ibuprofen, diclofenac, indomethacin, phenylbutazone, etc. For the last 15-20 years, “new” second-generation drugs have appeared on the market – selective inhibitors of cyclooxygenase-2 (COX): meloxicam, nimesulide and coxib group (celecoxib, etoricoxib).
The mechanism of action of non-steroidal anti-inflammatory drugs was discovered only in the early 70’s. At the heart of the work of all NSAIDs is the inhibition of the so-called cyclooxygenase enzyme.
Twenty years after its discovery, in the early 90’s, scientists discovered that this enzyme has two sub-enzymes: cyclooxygenase-1 and cyclooxygenase-2. And depending on what kind of medicine which enzyme depresses, it can have different effects. For the discovery of the mechanism of action of NSAIDs, scientists received the Nobel Prize in Medicine.
Thus, first-generation drugs affect both sub-enzymes and are nonselective: therefore, they not only have antipyretic and analgesic effect, but also cause side effects typical for NSAIDs: ulcerogenic effect (provokes ulceration), nephrotoxicity, ability to cause bronchospasm, organism of urine (oligouria).
Often, doctors do not have time to notice the side effect of taking a febrifuge and anesthetic drug. It turns out that in the future they can not take it into account when prescribing drugs to other patients. And patients themselves with uncontrolled drug intake can not understand that the side effects are caused by them.
Second-generation drugs (selective) have much fewer side effects typical of NSAIDs of the first generation (gastrointestinal lesions), but it turns out that they have a bad effect on heart function.
Symptomatic treatment does not involve systemic, constant use of antipyretic and analgesic drugs. If the doctor suggests taking such medications constantly, you should be alert. Because in doses that are acceptable for one-time use, side effects will be minimal.
Is it necessary to bring down the temperature?
Elevated temperature is a way of resisting the disease. At this time, the body produces a substance called interferon. With a decrease in temperature, the production of interferon is inhibited, which means that the resistance of the organism decreases.
In general, do not worry about the temperature, if it is “not dangerous”: in the vast majority of cases it is the temperature to 38-38.5 C. But it is not dangerous only if you are sure of the diagnosis and know that the high temperature is caused not by a bacterial infection. It is mandatory to knock down febrile temperature, accompanied by cramps, and also, if you have experienced the fever that once provoked convulsions.
Acetylsalicylic acid is a multi-functional medicine: it lowers the temperature, anesthetizes and has an anti-inflammatory effect. However, with a cold, taking this drug (especially for children under 12 years old) can cause severe liver damage and the central nervous system – Ray’s syndrome. It is not recommended to take it to those who suffered from gastric ulcer.
To prevent the formation of thrombi, doctors recommend taking 75-150 mg of acetylsalicylic acid per day. To strengthen the therapeutic effect, you need to take it with acidic drinks – for example, juice. And you should remember about the possible side effects.
Many doctors put paracetamol in the first place in reducing the temperature. It is not an anti-inflammatory drug and does not have the side effects of NSAIDs. Paracetamol in average therapeutic doses practically does not cause side effects. In extremely rare cases tissue hypoxia and rash may develop.
Cautions about hepatotoxicity (harmful effects on the liver) are associated with non-compliance with the rules of admission. A serious poisoning effect on the liver is a one-time intake of 10 g of paracetamol – 20 tablets in a dosage of 0.5 g. A person who took this dose would hardly have done it unconsciously.
If a person is healthy and does not have liver and kidney diseases (the organs that process and dispose of paracetamol decay products) there will be no problems with its administration. Unambiguously, it is contraindicated in renal failure, alcoholism, as well as in combinations with other drugs, for example, that contains phenobarbital or other inducers of liver enzymes, which include ethanol.
To avoid side effects when using paracetamol in both adults and children, the exact dosage of the drug should be observed: a single dose for children should be 10-15 mg / kg. It is advisable to use the drug once – when the temperature rises, and not four times a day – “just in case”.
More than 25 years ago, American scientists have proved the toxic-allergic effect of metamizole sodium. This means that after the first injection, it can cause severe allergic reactions, which do not depend on the dose of the drug.
According to the American Academy of Medical Sciences, if, for example, penicillins (one of the most “allergic” groups of drugs) cause anaphylactic shock, in one case from 5-7 million, then for metamizole the frequency of this side effect is one case by 40-50 thousands of people. Anaphylactic shock is always a mortal danger.
Scientists have proved that the drug causes agranulocytosis, it provokes a decrease in the number of white blood cells in the blood and the person becomes practically helpless before bacteria and fungi. However, the same side effects are present in all pyrazolone groups, indomethacin also belongs to them.
It relieves pain, but after two applications it causes oliguria and leads to electrolyte disorders, which can be fraught with a violation of the heart.
For a long time, the only advantage of metamizole before other antipyretic and analgesic drugs was the presence of an injectable form. About 5 years ago paracetamol appeared for parenteral administration, but its cost is higher.
Ibuprofen and Diclofenac
Medicines based on Ibuprofen and Diclofenac (Voltaren) are among the safest antipyretic drugs. Caution should be taken to take combined antipyretic drugs. Actually, they will work, but they will have side effects more, in proportion to the number of components in them.
In some combined preparations, paracetamol and phenobarbital adjoin the composition, which is not very advisable: phenobarbital contributes to the more active formation of a toxic product of the decay of paracetamol (metabolite), which increases the toxicity of paracetamol.
On the most common types of pain (dental and headache), all NSAIDs will necessarily work. If the pain is caused by inflammation (arthritis, bursitis), then the best anti-pain effect will be in that medicine that has higher anti-inflammatory properties (diclofenac drugs win).